ch. 11

11. 6

- brain relies on continuous supply of oxygen delivered via blood in order to survive - stroke (cerebrovascular accident): occurs when blood supply to brain is interrupted, killing briain cells as result of oxygen deprivation - brain cells have little capacity to heal or regenerate, while some recovery after types of stroked is possible, rehab may be lengthy, difficult & limited / depression is issue for survivors - strokes may be ischemic (caused by plaque or clot that reduces blood flow) or hemorrhagic (caused by bulging or rupture of weakened blood vessel) - aneurysm is most life-threateneing hemorrhagic stroke - mild strokes: cause temporary dizziness, weakness, or numbness -more serious may impair speech, memory, motor control often affection one side of body / other strokes affect heart & lung function regulation killing within minutes - major strokes are preceded days, weeks, or months earlier by transient ischemic attacks (TIAs): brief interruption of brain's blood supply that cause temporary impairment -symptoms of TIAs: dizziness, falls, blackouts, weakness, temporary paralysis or numbness, temporary memory loss, blurred vision, nausea, headache, & difficulty speaking / some have no obvious symptoms - one great medical success is recent years is the decline in death rate from strokes in US has dropped by one-third since 1980s - stroke still affects 7.0 million Americans & kills 133,000 people annually / 5th leading cause of death in US - 10% of strokes occur in people age 18-50 & are on increase among young adults

11. 1

- cardiovascular system in network of organs & vessels through which blood flows, carrying oxygen & nutrients to all parts of body (includes heart, arteries, arterioles, (small arteries) veins, venules (small veins), & capillaries (minute blood vessels)) - heart is a muscular four chambered pump, roughly size of your fist, highly efficient extremely flexible organ that contracts over 100,000 times each day pumping equivalent of 2,000 gallons of blood to all areas of body / in 70 year lifetime an average human heart beats 2.5 billion times - human body contains 6 quarts of blood that transports nutrients, oxygen, waste products, hormones, & enzymes throughout body - blood aids in regulating body temp., cellular water levels & acidity levels of body components & helps defend body against toxins & harmful microorganisms -hearts four chambers work together to circulate blood constantly throughout body -2 large upper chambers; atria / receive blood from rest of body -2 lower chambers; ventricles / pump blood out again -small valves regulate steady rhythmic flow of blood & prevent leakage or backflow between chambers - arteries: carry blood from away from the heart / carry oxygenated blood except pulmonary arteries which carry deoxygenated blood to lungs where blood picks up oxygen & releases carbon dioxide -arteries branch off from heart then divide into smaller vessels called arterioles then into even smaller capillaries -capillaries: have thin walls that permit the exchange of oxygen, carbon dioxide, nutrients, & waste products between blood & body cells -carbon dioxide & other waste products are transported to lungs & kidneys through veins & venules -heartbeat is governed by an electrical impulse that directs heart muscle to move, resulting in sequential contraction of the chambers , signal starts in small bundle of highly specialized cells in right atrium called sinoatrial node (SA node) which serves as natural pacemaker -average adult heart at rest beats 70-80 times per minute

11. 14

- risk factors: hereditary & acquired (environmental) risks / hereditary cannot be changed but acquired can be potentially modifiable - 78% of cancers are diagnosed at age 55 & above -lifetime risks referees to probability that an individual will develop cancer & die from it -in US men have lifetime risk of 42% & women 33% - relative risk is a measure of the strength of relationship between risk factors & particular cancer / compares your risk of cancer if you engage in certain unknown risk behaviors with that of someone who does not ( for example men & women who smoke have 25 times the risk of lung cancer of a nonsmoker - relative risk of 25%) - tobacco is responsible for 1 in 5 deaths annually - 480,000 premature deaths each year - 42,000 deaths from secondhand smoke - smoking is associated with increased risk of at least 15 different cnacers including casual relationships between smoking & liver cancer, colorectal polyps, colorectal cancer -smoking accounts for 32% of all cancer deaths & 80% of all lung cancer deaths in US - alcohol is a risk factor for cancer (oral cavity, pharynx, esophagus, colorectal, liver, larynx, & female breast cancer) -high levels of drinking are associated with some other cancers like pancreas & prostate cancer & melanoma - obesity contributes to 1 in 5 cancer deaths - relationship between high BMI & death rates from cancers of esophagus, colon, rectum, liver, stomach, kidney, pancreas, & high risk of endometrial cancer among younger women age 18-25 with higher BMIs & rapid weight gain - no relationship between job strain & risk for colorectal, lung, breast, or prostate cancer, people under chronic severe stress or who suffer from depresion or other persistent emotional problems do show higher rates of cancer than their healthy counterparts - sleep disturbances, unhealthy diet, & emotional or physical trauma may weaken body's immune system increasing susceptibility to cancer - possible contribution to cancers: po verty & health disparities associated with low socioeconomic status - 5-10% of all cancers are strongly hereditary - suspected cancer-causing genes are called oncogenes / typically dormant, but age, stress, & exposure to carcinogens, viruses, & radiation may activate them causing cells to grow & reproduce uncontrollably - cancer that run in families: breast, stomach, colon, prostate, uterus, ovaries, & lungs - factors that increase risk of breast cancer: having higher than average number of fertile or menstrual cycle years, not having children or having them later in life, recent use of birth control pills or hormone replacement therapy opting not to breast-feed / these do not have strong influence in Hispanic women / Hispanic women use less hormone replacement therapy & have lower utilization rate for mammograms, lower age at first birth & greater number of births - 90% of cancers are caused by cellular mutations & environmental factors that occur as result of inflammation including chronic infections (20%), tobacco smoking & particulates like asbestos (30%), dietary factors & obesity (35%) / inflammation appears to be ey factor in colorectal cancer with GI tract inflammatory problems having higher risk of cancer development - carcinogens (cancer-causing agents): asbestos, nickel, chromate, benzene, arsenic, vinyl cholride / also certain dyes & radioactive substances, coal tars, inhalants, & possible some herbicides & pesticides - ionizing radiation (radiation from X-rays, radon, cosmic rays, ultraviolet radiation (UVB)) has been proven to cause human cancer - virtually any part of body can be affected by ionizing radiation but bone marrow & thyroid are susceptible -radon exposure in homes can increase risk for lung cancer especially in cigarette smokers - to reduce risk of harmful effects, diagnostic medical & dental x-rays are set at lowest dose levels possible - nonionizing radiation produced by radio waves, cell phones, microwaves, computer screens, tv, electric blankets, & other products has not proven excess risk - over 10% of all cancers in US & 15-20% worldwide are caused by infectious agents like viruses , bacteria, or parasites - infections influence cancer development through chronic inflammation, suppression of immune system or chronic stimulation - viruses like the ones that cause chronic forms of hepatitis B & C chronically inflame liver tissue which make it more hospitable for cancer development - global increase in hepatitis B & C & liver cancer indicate association - every year in US 28,500 men & women get cancer linked to human papillomavirus (HPV) infection which cause most cervical, vulvar, vaginal, anal, & oropharyngeal cancers in females & most oropharyngeal, anal, & penile cancers in males / HPV vaccines can prevent infection & linked cancers - heliobacter pylori is a bacterium found in stomach lining of 30% of Americans / causes irritation, scarring, & ulcers, damaging lining of stomach & leading to cellular changes that lead to cancer -more than half of all cases of stomach cancer may be linked to H. pylori / antibiotic treatment has been effective in treating & reducing risk of new stomach cancers - hormone replacement therapy (HRT) used for relieving women's meopausal symptoms increases risk of breast & overian cancer; use of estrogen therapy has declined

11. 22

-magnetic resonance imaging (MRI): uses powerful electromagnet to detect tumors by mapping vibrations of atoms in body on computer screen -computerized axial tomography (CAT) scan: uses x-rays to examine part of body. - prostatic ultrasound (rectal probe that uses ultrasonic waves to produce image of prostate) is being investigated as a means to increase early detection of prostate cancer combined with PSA blood test -mammography is a specialized x ray technique that can detect abnormalities in breast - new 3D mammogram machines offer significant improvements in imaging & breast cancer detection but with tradeoff that they deliver nearly double radiation risk of conventional mammogram equipment - if scans detect possible cancer, very often a biopsy (removal of suspected abnormal tissue) is done so that sample can be analyzed for cell type by a lab - stereotactic radiosurgery: also known as gamma knife surgery uses targeted dose of gamma radiation to zap tumors without any blood loss - radiotherapy (use of radiation) & chemotherapy (use of drugs) used to kill cancerous cells / radiation is most effective in treating localized cancer because it can be targeted to particular area: side effects of radiotherapy are fatigue, changes to skin in affected area, & slightly greater chances of developing another type of cancer -chemo may be used to shrink tumor before or after surgery or radiation therapy or on It's own / powerful drugs are administered usually in cycles so body can recover from effects / side effects: nausea, hair loss, fatigue, increased chance of bleeding, bruising, infection, anemia, fade after treatment, loss of fertility may be permanent / - both can cause long term damage to cardiovascular & other body systems - 77% of cancers are diagnosed in adults age 55 or older - immunotherapy: designed to enhance body's disease fighting systems & use immune system to fight cancer / increases strength of immune response against tumors or counteract cancer cell signals that suppress immune response - biological therapies: cancer-fighting vaccines alert body's immune defenses to cells gone bad / rather than preventing disease as other vaccines do, they help people who are already ill - gene therapies: viruses may carry genetic info that makes cells they infect (cancer cells) susceptible to an antiviral drug / looking at ways to transfer genes that increase immune response to cancerous tumor or that confer drug resistance to bone marrow so higher doses of chemo drugs can be given - angiogenesis inhibitors: some compounds may stop tumors from forming new blood vessels process called angiogenesis / without adequate blood supply tumors either die or grow very slowly - disruption of cancer pathways: steps in cancer pathway include oncogene actions, hormone receptors, growth factors, metastasis & angiogenesis / preliminary studies are underway to design compounds that inhibit actions at each of these steps -smart drugs: targeted smart drug therapies attack only cancer cells not entire body - enzyme inhibitors: an enzyme TIMP2 shows promise for slowing metastasis of tumor cells/metastasis suppressor gene, NM23, has also been identified - neoadjuvant chemotherapy: method uses chemo to shrink tumor before surgically removing it - stem cell transplants: transplants of healthy stem cells from donor bone marrow are used to treat cancers of blood when patient's bone marrow has been destroyed by disease, chemo, or radiation

11. 25

- Generally, a physician orders one of the following blood tests to diagnose prediabetes or diabetes: The fasting plasma glucose (FPG) test requires the patient to fast overnight; a small sample of blood is then tested for glucose concentration. An FPG level greater than or equal to 100 mg/dL indicates prediabetes, and a level greater than or equal to 126 mg/dL indicates diabetes The oral glucose tolerance test (OGTT) requires the patient to drink a fluid containing concentrated glucose. Blood is drawn for testing 2 hours later. A reading greater than or equal to 140 mg/dL indicates prediabetes, and a reading greater than or equal to 200 mg/dL indicates diabetes. The A1C or glycosylated hemoglobin test (HbA1C) gives the average value of a patient's blood glucose over the past 2 to 3 months instead of at one moment in time. In general, an A1C of 5.7 to 6.4 means that the patient is at high risk for diabetes or is prediabetic. If the A1C is 6.5 or higher, diabetes may be diagnosed. Estimated average glucose (eAG) shows how AIC numbers correspond to the blood glucose numbers people are used to seeing. For example, someone with an A1C value of 6.1 would be able to look at a chart and see that his or her average blood glucose was around 128—a high level that should encourage healthy lifestyle modifications. - Lifestyle changes can prevent or delay the development of type 2 diabetes by up to 58 percent.169 For people with type 2 diabetes, such lifestyle changes can prevent or delay need for medication or insulin injections. -Losing 5-7% of body weight can cause significant reductions in blood glucose levels and help prevent diabetes. - Weight loss significantly lowers risk of progressing from prediabetes to diabetes. A loss of as little as 5 to 7 percent of current body weight and regular physical activity significantly lower the risk of progressing to diabetes.170 A low-fat, reduced-calorie diet aids weight loss. Researchers have studied a variety of foods for their effect on blood glucose levels. A diet high in whole grains reduces risk of type 2 diabetes.171 Eating high-fiber foods—berries, vegetables, beans, nuts, and seeds—may reduce diabetes risk.172 Eating low-carbohydrate diets also appears to reduce overall CVD risks and may have a significant effect on preventing and controlling type 2 diabetes. In addition, consumption of fish that is high in omega-3 fatty acids is linked with decreased progression of insulin resistance. However, newer research has called this connection between high fish intake and risk reduction into question.173 More research is necessary. It is important for people with diabetes to prevent surges in blood sugar after they eat. The glycemic index (GI) compares foods with the same amount of carbohydrates and determines how quickly and how much each raises blood glucose levels. Foods that are low on the GI have far less effect on blood glucose than those that are high on the GI. A food's glycemic load (GL) is defined as its GI (potential to raise blood glucose) multiplied by the grams of carbohydrates it provides, divided by 100. By learning to combine high- and low-GI foods to avoid surges in blood glucose, diabetics can help control their average blood glucose levels throughout the day. Eating smaller amounts, several times a day, from low GI sources is an important part of glucose control. In late 2016, the American Diabetes Association changed their exercise recommendations for diabetes prevention, calling for based on information found in source light activity every 30 minutes during long sitting stretches. Rather than prescribing 90 minutes of exercise over several days, getting people up and moving at more regular intervals is key to glucose control.174 Exercise increases sensitivity to insulin. The more muscle mass you have and the more you use your muscles throughout the day, the more efficiently cells use glucose, meaning less glucose circulating in the bloodstream. - When lifestyle changes fail to control type 2 diabetes, one of several oral medications may be prescribed, each of which influences blood glucose in a different way: reducing the liver's glucose production, slowing absorption of carbohydrates from the small intestine, increasing pancreatic insulin production, or increasing cells' insulin sensitivity. Drugs known as SGLT2 inhibitors cause the kidneys to actually excrete more glucose, which lowers the levels of glucose circulating in the body. All diabetes drugs have side effects and contraindications; however, each person must balance risks of medications with risks of elevated blood glucose. Currently, there is much discussion about whether people with prediabetes should use the drug metformin, along with lifestyle intervention and counseling, as an early intervention. Although sources indicate potential benefits, metformin is not without risks, particularly for Individuals with a history of gastrointestinal, cardiovascular, or kidney problems.175 People who undergo gastric or bariatric surgery have shown remarkable reductions in blood glucose and diabetes symptoms more than 2 years after surgery.176 Those who combined gastric bypass or sleeve gastrectomy with intensive medical therapy had similar outcomes.177 In many cases, former diabetics can stop taking some medications, and their diabetes symptoms stop altogether. Consensus is growing about potential short- and long-term benefits of these more drastic methods.178 However, gastric bypass surgeries are not without risks, which can include death and serious complications. With type 1 diabetes, the pancreas cannot produce adequate insulin, making added insulin essential. People with type 2 diabetes whose blood glucose cannot be controlled with other treatments also require insulin. Insulin cannot be taken in pill form because it is a protein and therefore would be digested in the gastrointestinal tract. It must therefore be inserted into the fat layer under the skin, from which it is absorbed into the bloodstream. Today, many diabetics use an insulin infusion pump rather than injections. The pump, which is small and easily hidden by clothes, delivers insulin in minute amounts throughout the day through a catheter inserted under the skin.

11. 18

- after skin cancer, prostate cancer is most frequently diagnosed in american males with 151,360 new cases in 2017 / third leading cause of cancer deaths in men killing 26,730 men in 2017 - 5 year survival rate with improved screening & early diagnosis 100% / advanced cases 29% - prostate is muscular, walnut, sized gland that surrounds part of a mans urethra, tube that transports urine & sperm out of body - prostate is part of reproductive system primary function being to produce seminal fluid -symptoms: weak or interrupted urine flow, difficulty starting or stopping urination, feeling urge to urinate frequently, pain on urination, blood in urine, pain in low back, pelvis, or thighs / many men have no symptoms in early stages -men over age 40 should have annual digital prostate examination -screening method for prostate cancer is prostate specific antigen (PSA): blood test that screens for an indicator of prostate cancer - risk factors: increasing age is one of the biggest, african ancestry, fam history of prostate cancer - over 97% of cases occur in men over age 50 -genetics may account for 5-10% of cases overall -black men in US & caribbean men of african descent have highest documented prostate cancer incidence rates in the world & are more likely to be diagnosed at more advanced stages than other racial groups - having father or brother with prostate cancer more than doubles a man's risk of getting prostate cancer -prevention: eating more fruits & veggies particularly those containing lycopene, pigment found in tomatoes & other red fruits may lower risk of prostate cancer death - diets high in processed meats or fair & obesity appear to increase risk -testicular cancer is common type of solid tumors found in young adult men affecting 8,720 young men in 2017 / over one half of of all cases occur between ages of 20-34 with steady increases in this group -95% 5-year survival rate, most curable forms of cancer, especially if caught in localized stages -men with undescended testicles appear to be at greater risk / some studies indicate genetic influence -risks are higher if you're wight, have HIV or AIDS or if primary relative has had testicular cancer - testicular tumors first appear an enlargement of testis or thickening in testicular tissue / some have reported a heavy feeling, dull ache, pain that extends to lower abdomen or groin area -testicularbut are not cost effective self-examinations have been recommended for teen boys & young men -most cases are found through self-exam - testicular self-exam is best done after a hot shower / will relax scortum & make exam easier / standing in front of mirror hold testicle with one hand while gently rolling It's surface between thumb & fingers of your other hand , feel underneath scrotum for tubes of epididymis & blood vessels that sit close to bdy, repeat with other testicle / be attentive for any lump, thickening, or pea-like nodules & any areas that may be painful over entire surface of scrotum

11. 9

- cigarettes are leading cause of preventable deaths in US causing more deaths each year than HIV, alcohol abuse, car accidents, & firearm-related deaths combined - smokers are 2 to 4 times more likely to develop coronary heart disease & stroke -smoking causes 90% lung cancers, 80% COPD - social smoking has been found to result in a major increase in CVD risk -nonsmokers who regularly are exposed to secondhand smoke have a 25-30% increased risk of heart disease with over 35,00 deaths per year - if you stop smoking, your heart & lungs can begin to mend themselves, after 1-2 years formoers smoker's risk of heart disease drops, respiratory symptoms begin to improve, risks of lung & other cancers drop & among women who smoke , risk of infertility & low birth weight babies decrease - diets high in saturated fat & trans fat raise cholesterol levels & increase risk of heart attacks, stroke, & atherosclerosis / cutting back on saturated fat decreases risk of CVD - 75% of cholesterol found in your body comes from your body -cholesterol plays role in production of cell membranes & hormones& helps process vitamin D -two components to cholesterol: low-density lipoproteins (LDL): bad cholesterol, build up on artery walls / high density lipoprotein (HDL): good cholesterol, removes buildup -lipoprotein-associated phospholipase A2 (Lp-PLA2): enzyme that circulates in blood & attaches to LDL; plays important role in plaque accumulation & increased risk for stroke & coronary events particularly in men -apolipoprotein B (apo B): primary component of LDL essential for cholesterol delivery to cells / important to heart disease risk than total cholesterol or LDL levels - body converts extra consumed calories into triglycerides: stored in fat cells to provide energy - high counts of blood triglycerides are found in people who are obese or overweight or who have high cholesterol levels, heart problems, or diabetes - baseline cholesterol test (lipid panel or lipid profile) measures triglyceride, HDL, LDL, & total cholesterol (should have one done at age 20 with follow ups every 5 years then annually for men over 35 & for women 45) - eat lots of fiber: 5-10 milligrams per day of soluble fiber from oat bran, fruits, vegs, legumes, & psyllium seeds - consume 2 grams per day of plant sterols: present in many fruits, veggies, nuts, seeds, cereals, legumes, vegetable oils & other plant sources -cut down on dietary sodium, table salt is 40% sodium, excess sodium is linked to high blood pressure & can affect CVD risk - foods that reduce chance that cholesterol will be absorbed in cells,reduce levels of LDLD, cholesterol or enhance protective effects of HDL: fish high in omega-3 fatty acids , olive oil, whole grains, nuts, green tea, dark chocolate - exercise can increase HDL levels, lower triglyceride levels & reduce coronary risks - heart disease death rates among adults w diabetes are 2-4 times higher than rates for adults without diabetes -at least 65% of people with diabetes die of heart disease or stroke

11. 23

- diabetes mellitus: group of diseases each with It's own mechanism but all characterized by persistently high level of glucose (sugar) in blood - high blood glucose levels (known as hyperglycemia) can lead to widespread damage in body -serious health conditions related to diabetes include heart disease, stroke, failure of wounds on extremities to heal (leading to infection & amputations), nerve damage, kidney failure, liver damage, & blindness - in 2015 diabetes was primary cause of death for over 79,000 Americans, 1,6 million deaths directly caused by diabetes worldwide - 39.9% or 84.1 million people in US aged 18 & over are prediabetic - glucose is preferred fuel most body cells use to conduct many other necessary metabolic functions - when surge of glucose enters bloodstream from digestive system, the pancreas an organ just beneath the stomach, secretes a hormone called insulin / this stimulates cells to take up glucose from bloodstream - insulin also assists in conversion of any excess glucose into molecule glycogen which is stored in liver & muscles -average adult has 5-6 grams of glucose in blood at any given time =, which is enough to provide energy for 15 minutes of activity / if blood glucose becomes depleted the body draws on It's glycogen reserves - type 1 diabetes (insulin-dependent diabetes) is an autoimmune disease where immune system attacks & destroys insulin-making cells in pancreas / by reducing or stopping insulin production, cells cannot take up glucose & blood glucose levels become permanently elevated - type 1 used to be called juvenile diabetes because it most often appears during childhood or adolescence / only 5% of diabetic cases are type 1 / European ancestry , a genetic predisposition, & certain viral infections all increase risk / people with type 1 require daily insulin injections(or regular infusions from an insulin pump) & must carefully monitor their diet & exercise levels - type 2: (non-insulin-dependent diabetes) accounts for 90-95% of all cases / pancreas does not make enough insulin or body cells become resistant to It's effects & don't efficiently use available insulin, a condition referred to as insulin resistance -type 1 can appear suddenly but type 2 develops slowly -in early stages of type 2 cells begin to resist effects of insulin / one contributor to insulin resistance in an overabundance of free fatty acids in fat cells (common in obese individuals) / these free fatty acids inhibit cells' glucose uptake & diminish the liver's ability to self-regulate conversion of glucose into glycogen - as blood levels of glucose gradually rise, pancreas attempts to compensate by producing more insulin / over time more pancreatic insulin-producing cells sustain damage & become nonfunctional -as insulin output declines, blood glucose levels rise enough to warrant diagnosis of type 2 - # of people with diabetes rose from 108 million in 1980 to 422 million in 2014 , half of those with the disease are found in 5 countries: china, India, US, brazil, Indonesia - 30 million Americans have the disease / lowest diabetes rates are in Switzerland, Netherlands, denmark, Austria, & Belgium -rates have risen the fastest in low & middle income nations where access to prevention & treatment may be lacking -WHO projects that by 2030 diabetes will become 7th leading cause of death worldwide, in US researchers believe that as many as 1 in 3 adults will be diabetic by year 2050 / combined burden form diabetes was estimated at over $245 in 2012

11. 21

- mindfulness-based interventions (MBIs) for cancer survivors care; have proven effective in helping people deal with diagnosis, treatment & life as survivors / help cope with loss of control, uncertainty about future, fear of recurrence -mediation, yoga, mindfulness-based stress reduction (MBSR) & other spirituality based techniques -MBSR programs are 8 weeks long with session that last for 2-3 hours each week

11. 19

- most common form of cancer in US - skin cancer incidence isnt reported to cancer registries as other type of cancers are -most skin cancers are either basal cell carcinoma or squamous cell carcinoma which are highly treatable & not life threatening -most skin cancer deaths (10,000 in 2017) are caused by serious form of skin cancer known as malignant melanoma (affects over 87,000 people in US each year) / majority of these deaths are in white men over age of 50 with rare cases among african americans - basal & squamous cell carcinomas develop on face, ears, neck, arms, hands & legs as warty bumps, colored spots, or scaly patches / bleeding, itchiness, pain, & oozing may occur -surgery may be necessary to remove these carcinomas, they seldom spread & are typically not life threatening - melanoma: invasive killer that may appear as a skin lesion / lesion's size & shape or color changes & spreads to regional organs & throughout body -if melanoma has not yet penetrated underlying layers of skin, chances for survival are over 98%, if it is diagnosed after deeper layers of skin have been penetrated & has spread to other organs survival rate falls to 17% -warning signs of melanoma as ABCDE rule: * asymmetry: one half does not match other half *border irregularity: edges are uneven, notched, or scalloped *color: pigmentation is not uniform, may vary in color from tan to deeper brown, reddish black, black, or deep bluish black *diameter: diameter is greater than 6 millimeters (size of pea) *evolving: size, symmetry, shape, color, border, or other characteristics change over time - depending on type, stage, & location of cancer, treatment options include surgery, laser treatment, topical chemical agents, electrodessication (tissue destruction by heat), & cryosurgery (tissue destruction by freezing) / for melanoma treatment may involve surgical removal of regional lymph nodes, radiation, or chemotherapy - anyone who overexposes themselves to ultraviolet (UV) radiation without adequate protection is at risk for skin cancer ; usually comes from sun exposure, tanning booths or beds -risk is greater for people who: * have fair skin & light eyes * always burn before tanning or burn easily & peel readily *don't tan easily but spend lots of time outdoors *use no or low SPF or expired sunscreens * have had skin cancer or have fam history of skin cancer * experienced severe sunburns during childhoods - preventing skin cancer: limiting exposure to harmful UV rays -skin responds to exposure by increasing It's thickness & number of pigment cells (melanocytes) which produce darker tanned skin / UV light damages skin's immune cells,lowering normal immune protection of skin & priming it for cancer / photodamage also causes wrinkling by impairing collagens that keep skin soft & pliable

11. 7

- other cardiovascular diseases: angina pectoris, arrhythmias, congestive heart failure, childhood cardiovascular defects - angina pectoris: "strangling of chest" occurs when inadequate oxygen supply to heart muscle results in chest pain or pressure / not a heart attack but indicates underlying heart disease / 10 million people in US suffer from mild-severe symptoms like indigestion or heartburn like sensations to crushing chest pain -mild angina treatment: rest -severe angina treatment: drugs that affect either supply of blood to heart muscle or heart's demand for oxygen / pain & discomfort are relieved with nitroglycerin drug that relaxes (dilates) veins improving blood flow to heart -patients with angina caused by spasms of coronary arteries are given calcium channel blockers which prevent calcium atoms from passing through arteries & causing contractions / beta-blockers control potential overactivity of heart muscle - most people experience some type of arrhythmia: an irregularity in heart rhythm that occurs when electrical impulses that coordinate heartbeat don't work properly -person with racing heart in absence of exercise or anxiety may be experiencing tachycardia: an abnormally slow heartbeat - when heart goes into fibrillation it beats in a sporadic pattern that causes extreme inefficiency in moving blood through cardiovascular system / if untreated, fibrillation can be fatal -common type of arrhythmias is preventricular contractions (PVCs): premature heart beats in ventricles - are on rise among all age groups / teens, young adults, & athletes seem particularly susceptible to PVCs - not all arrhythmias are life threatening / excessive caffeine or nicotine consumption can trigger an arrhythmia episode - severe cases may require drug therapy or external electrical stimulus to prevent serious complications - acute shortness of breath & fatigue are often key symptoms of heart failure (hf) or congestive heart failure (CHF) - 5.1 million adults in US have HF & cases are estimated to rise to nearly 10 million by 2030 -underlying causes of HF: injury that results in damage to heart muscle (cardiomyopathy), affects heart valves, or causes problems with heart rhythm -infectious diseases like rheumatic fever can damage heart valves - bacteria & viruses can inflame blood vessels increasing atherosclerotic plaque information -uncontrolled high blood pressure, coronary artery disease, diabetes, & other chronic conditions can all lead to heart failure -drugs like nonsteroidal anti-inflamamtory drugs (NSAIDs) & diabetes meds also increase risks as well as chronic drug & alcohol abuse -damage can also be cone due to cancer radiation or chemotherapy untreated HF can be fatal but most cases respond well to treatment - HF treatment: diuretics (drugs that increase urination) to relieve fluid accumulation / drugs like digitalis increase heart's pumping action / vasodilators: expand blood vessels & decrease resistance making heart's work easier - 40,00 children are born in US each year with some form of congenital cardiovascular defect (congenital: problem is present at birth) -congenital defect may be minor like slight murmurs (low pitched sounds caused by turbulent blood flow through heart) caused by valve irregularities which many children outgrow -25% of those born with congenital heart defects must undergo invasive procedures to correct problems within first year of life - underlying causes are unknown but may be related to hereditary factors: maternal diseases like rubella, that occurred during fetal development, or pregnant women's chemical intake (binge drinking, smoking & those who use methamphetamine) during pregnancy - greater risk for child if mother is diabetic, has high body mass index, & those with folate deficiency - rheumatic heart disease: attributed to rheumatic fever, an inflammatory disease caused by unresolved streptococcal infection of throat (strep throat) - over time strep infection can affect connective tissues of heart, joints, brain, or skin

11. 20

- ovarian cancer is 5th leading cause of cancer deaths for women with 23,00 diagnoses in 2017& 14,000 deaths -causes more deaths than any other cancer of reproductive system become women tend to not discover it until cancer is at advanced stage / 5-year survival rate is 29% / women under age of 45 are much mor elikely to survive.5 years than are women age 65 or older / average 5 year survival rate when all stages are combined is only 46% - woman with ovarian cancer may complain feeling bloated, having pain in pelvic area, feeling full quickly, feeling need to urinate more frequently / some may experience persistent digestive disturbances, fatigue, pain during intercourse, unexplained weight loss, unexplained changes in bowel or bladder habits, & incontinence - early stage treatment for ovarian cancer includes surgery, chemo, & radiation / depending on patients age & desire to bear children one or both ovaries, fallopian tubes & uterus may be removed - primary relatives of woman who has had ovarian cancer are at increased risk / family or personal history of breast or colon cancer is associated with increased risk -women who have never been pregnant are more likely to develop ovarian cancer than are those who have given birth - more children a woman has the less risk she faces -use of postmenopausal estrogen replacement therapy increases woman's risk also use of talcum powder, smoking, & obesity - using birth control pills, adhering to low-fat diet, having multiple children, & breastfeeding appear to reduce risk of ovarian cancer - women over 40 should have cancer-related checkup every year / uterine ultrasound or blood test is recommended for those with risk factors or unexplained symptoms - uterine cancers develop in body of uterus usually in endometrium / rest develop in cervix located at base of uterus - as more women have regular Pap test screenings (procedure where cells taken from cervical region are examined for abnormal activity) rates of these cancers should decline further - pap tests are effective for detecting early stage cervical cancer though less effective for detecting cancers of uterine lining - women have lifetime risk of 1 in 161 for being diagnosed with cervical cancer & 1 in 36 risk of being diagnosed with uterine corpus cancer - early warning signs of uterine cancer: bleeding outside normal menstrual period or after menopause or persistent unusual vaginal discharge -risk factors for cervical cancer: early age at first intercourse, multiple sex partners, cigarette smoking, certain STD including HPV (cause of genital warts), & herpes -for endometrial cancer, age, estrogen, & obesity are risk factors -risks are increased by treatment with tamoxifen for breast cancer, metabolic syndrome, late menopause, never bearing children, history of polyps in uterus or ovaries, history of other cancers & race, white women being at higher risk - leukemia is cancer of blood forming tissues that leads to proliferation of millions of immature white blood cells , these cells crowd out normal white blood cells (fight infection) , platelets (control hemorrhaging) , & red blood cells (carry oxygen to body cells) -leukemia symptoms: fatigue, paleness, weight loss, easy bruising, repeated infections, nosebleeds, & other forms of hemorrhaging - leukemia can be acute or chronic & can strike both sexes & all age groups (estimated 62,130 cases diagnosed in US in 2017) - chronic leukemia can develop over several months or years & have few symptoms in early stages, usually treated with radiation & chemo or bone marrow & stem cell transplants - lymphomas are among fastest-growing cancers with 80,500 new cases in 2017 / increase has occurred in women, cause is unknown but weakened immune system is suspected particularly one that ha been exposed to virues like HIV, hepatitis C & epstein-barr virus or is compromised through diseases like lupus or rheumatoid arthritis - treatment varies by type & stage; chemo, radiotherapy

11. 10

[ risk factors for CVD that cannot be controlled or prevented ] - race & ethnicity: african americans tend to have highest overall rates of CVD - among highest average blood pressure rates in world / mexican americans have highest percentage of adults with cholesterol levels exceeding 200 mg/dl & highest rates of obesity & overweight - heredity: family history of heart disease appears to increase CVD risk / amount of cholesterol produced, tendencies to form plaque / new research studied interactions between nutrition & genes (nutrigenetics) & role that diet may play in increasing or decreasing risks among certain genetic profiles - age: vast majority of heart attacks occur in those over age 65, increasing age ups the risk for CVD for all - gender: men are at greater risk for CVD until age 60, when women catch up & then surpass them / women under 35 have a fairly low risk although oral contraceptives & smoking increase risk / hormonal factors appear to reduce risk for women though after menopause womens LDL levels tend to rise - inflammation plays major role in development of atherosclerosis because injured vessel walls are more prone to plaque formation - cigarette smoke, high blood pressure, high LDL levels, diabetes mellitus, certain forms of arthritis, 7 exposure to toxins have been linked to increase risk of inflammation - greatest risk is infectious disease pathogens, most notably chlamydia pneumoniae (common cause of respiratory infections) , helicobacter pylori (bacterium that causes stomach ulcers) , herpes simplex virus, & cytomegalovirus (herpes virus that infects most americans before age 40) - c-reactive proteins (CRPs): during inflammatory reactions these tend to be present in blood at high levels - recent meta-analysis shows strong association between c-reactive proteins in blood & increased risks for atherosclerosis & CVD - doctors can test patients using an assay called hs-CRP; if levels are high, action could be taken to prevent progression to reduce inflammation - strong association between c-reactive proteins in blood & increased risks for atherosclerosis & CVD - blood tests can test these proteins using a highly sensitive assay called hs-CRP (high sensitivity c-reactive protein)

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[atherosclerosis: ] - based on greek words athero (gruel or paste) & sclerosis (hardness) -condition where fatty substances, cholesterol, cellular waste products, calcium, & fibrin (clotting material in blood) build up in inner lining of an artery [hyperlipidemia: ] - abnormally high blood lipid level -key factor in this process & resulting buildup is called plaque -as plaque accumulates, vessel walls become narrow & eventually block blood flow or cause vessels to rupture -pressure buildup is similar to that achieved when you put your thumb over the end of a hose while water is on, pressure builds within arteries just as pressure builds in hose - if vessels are weakened & pressure persists, vessels may burst or plaque itself may break away from walls of vessels & obstruct blood flow - fluctuation in blood pressure levels within arteries can damage internal arterial walls making it more likely that plaque will stick to injured wall surfaces & accumulate -atherosclerosis is often called coronary heart disease because of the damage to the body's main coronary arteries on outer surface of heart / these are arteries that provide blood to heart muscle / most heart attacks result from blockage of these arteries -atherosclerosis occurs in lower extremities: feet, calves, legs or arms : this is called peripheral artery disease (PAD) -8.5 million people (particularly non-hispanic blacks, women under age of 60, men over age of 60 in US) have PAD & aren't receiving treatment because they are asymptomatic or don't recognize subtle symptoms -symptoms of PAD: pain, aching in legs, calves, feet on walking or exercise (known as intermittent claudication) - PAD is leading cause of disability in people over age of 50 for both men & women / smokers & diabetics develop it more frequently -increased attention has been drawn to role of PAD in subsequent blood clots & resultant heart attacks, especially among people who sit in cramped airplanes for long distances without getting up & moving -PAD in arms can be caused by trauma, certain diseases, radiation therapy, surgery, repetitive motion syndrome, or combo of factors - atherosclerosis treatment: focuses on lifestyle changes, drugs that reduce risk of plaque, medical procedures to open vessels, surgery to open clogged vessels -millions of americans take drugs designed to reduce triglycerides & low-density lipoprotein (bad cholesterol / associated with CVD) & increase high-density lipoprotein (good cholesterol / helps protect against CVDl) -statins are most commonly prescribed meds for atherosclerosis; not without risk / common risk is muscle pain that ranges from mild to severe, other side effects are digestive issues, liver damage, increased risk of diabetes, memory loss

11. 2

- CVD death rates have declined ove rpast decade by about 33 percent - CVD claims more than 17 million lives around globe each year - more lives than the next two leading causes of death combined (cancer & chronic lower respiratory diseases) - by 2030 CVD deaths are expected to increase to nearly 24 million per year - many CVD related deaths are sudden cardiac deaths, an abrupt profound loss of heart function (cardiac arrest) that causes death either instantly or shortly after symptoms / 50% of men & 64% of women who die suddenly have had no previous symptoms -CVD has claimed more lives of women than men since 1984 - among women, african americans & asian/pacific islanders (south asians) have highest percentages of cvd deaths / 47% of all non-hispanic black women have some form of CVD -among men, asian/pacific islanders & african americans have highest percentages of CVD deaths at 32.8% 31.7% - american indians & alaska natives have lowest percentages of deaths from CVD - people 20-39, 20.3% have metabolic syndrome , dangerous grouping of key risk factors for CVD 40--59, rates jumps to 40.8% & 60 & over 52% - 25% of men & 38% of women will die within 1 year of having an initial heart attack -improvement in death rates of CVD: better diagnosis, early intervention, & steadily improving treatments including new drugs, improving our understanding about diet, activity, & other behaviors that affect risk of CVD - more than $316 billion in direct & indirect costs for CVD - by 2035, 45% of US population will have CVD -WHO estimates CVD accounts for 31% of all deaths globally

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- US burden of disease collaborators determined greatest contributor to overall CVD was suboptimal diet followed by tobacco smoking, high BMI, high blood pressure, high fasting plasma glucose, & physical inactivity - obesity & hypertension has increased risk for impaired cognitive function & increase in alzheimer's disease - cardiometabolic risks: combined risks which indicate physical & biochemical changes that can lead to disease -professional have attempted to establish diagnostic cutoff points for a cluster of combined cardiometabolic risks, variably labeled syndrome X, insulin resistance syndrome & most recently metabolic syndrome -metabolic syndrome increases risk for atherosclerotic heart disease by as much as three times normal rates -women are more likely than men to have metabolic syndrome / highest occurs in hispanics followed by non hispanic whites & blacks -as age increases so does metabolic syndrome (MetS) affecting over 18% of 20-39 year olds nearly 47% of people age 60 -diagnosis requires three or more risks

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- breast cancer is group of diseases that cause uncontrolled cell growth in breast tissue in glands that produce milk & ducts that connect those glands to nipple / can also form in connective & lymphatic tissues of breast - women have 1 in 8 lifetime risk of being diagnosed with breast cancer / for women from birth to age 49 the chance is about 1 in 53 / rates are higher after menopause - in 2017, 252,710 women & 2,500 men in US will be diagnosed with invasive breast cancer for first time -63,500 new cases of in situ breast cancer (localized cancer) were diagnosed - over 40,600 women (& 450 men) died making breast cancer second leading cause of cancer death for women - earliest signs of breast cancer are usually observable on mammograms often before lumps can be felt -mammograms are not foolproof & there is debate about age at which women should start having the done regularly / self-examination (BSE) can be useful - newer form of MRI, though not recommended as a screening tool, appears to be more accurate than mammograms particularly in women with genetic risks for tumors or those who have suspicious areas of breast or surrounding tissue that warrant a clearer image -symptoms of breast cancer: lump i breast or surrounding lymph nodes, thickening, dimpling, skin irritation, distortion, retraction or scaliness of nipple, nipple. discharge or tenderness - BSE did not lead to earlier detection of cancer - treatment for breast cancer: lumpectomy to radical mastectomy to combos of radiation or chemotherapy / promising results in using selective estrogen-receptor modulators (SERMs) not surgical : tamoxifen & raloxifene / these drugs as well as aromatase inhibitors work by blocking estrogen - 5 year survival rate for people with localized breast cancer has risen from 80% in 1950s to over 90% today - survival rate for black women is 11% lower overall than that for white women - incidence of breast cancer increases with age - risk factors: fam history of breast cancer, menstrual periods that started early & ended late in life, weight gain after age of 18, obesity after menopause, recent use of oral contraceptives or postmenopausal hormone replacement therapy, never bearing children or bearing a first child after age 30, consuming 2 or more drinks of alcohol per day & physical inactivity, smoking, having dense breasts, type 2 diabetes, high bone mineral density, shift work & sleep deprivation, dietary risks & exposure to high-dose radiation -BRCA1 & 2 gene mutations are rare & occur in less than 1% of population, account for 5-10% of all cases of breast cancer

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- cancer: large group of diseases characterized by uncontrolled growth & spread of abnormal cells / when something interrupts normal cell programming, uncontrolled growth & abnormal cellular development result in neoplasm: new growth of tissue serving no physiological function / neoplasmic mass often forms a clump of cells known as tumor - not all tumors are malignant (cancerous); most are benign (noncancerous) -benign tumors are harmless until they grow to obstruct or crowd out normal tissues - benign tumor of brain may become life threatening if it grows enough to restrict blood flow & cause a stroke / only way to determine if tumor is malignant is through a biopsy or microscopic examination of cell development -benign tumors consist of ordinary looking cells enclosed in a fibrous shell or capsule that prevents their spreading to other body areas -malignant tumors are not enclosed in a protective capsule & can therefore spread to other organs / this is known as metasis: makes some form of cancer particularly aggressive in their ability to overwhelm bodily defenses -malignant tumors frequently metastasize throughout body making treatment difficult -benign tumors merely expand to take over given space but malignant cells invade surrounding tissue emitting clawlike protrusions that disturb the RNA & DNA within normal cells / disrupting these substances that control cellular metabolism & reproduction produces mutant cells that differ in form, quality, & function from normal cells

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- colorectal cancers (colon & rectum) are third most commonly diagnosed cance rin both men & women / second leading cause of cancer deaths in men & third leading cause of death in women - in 2017 95,520 cases of colon cancer & 39,910 cases of rectal cancer were diagnosed in US & 50,260 deaths were attributed to colon or rectal cancer -rates of colon cancers declining in people age over 50 they increasing among those under age 50 - younger men & women have 1 in 300 risk of developing colon & rectal cancer form birth to age 49 & increases to 1 in 21 to 22 later in life - colorectal cancer spreads slowly / 5 year survival rate for cases diagnosed early in localized stages is over 90% - 14% if it has spread to other areas of body - early stages are asymptomatic, many cases are diagnosed at later stages -major warning signals: bleeding from rectum, blood in stool, changes in bowel habits - should begin having colonoscopies at age 50 - virtual colonoscopies & fecal DNA testing are newer, less invasive & have shown promise -basic screening test: at home fecal blood test / detects blood in stool - 35% of whites, 38% of blacks, 46% Hispanics, & 51% of asians over age 50 have not been screened -treatment for colorectal cancer: radiation, surgery & maybe chemo - increased risk if: older than age 50, obese, fam history of colon & rectal cancer, personal or family history of polyps in colon or rectum, or have inflammatory bowel problems like colitis, history of diabetes - possible risk factors for colorectal cancer: diets high in fat or low in fiber, high consumption of red & processed meats, smoking, sedentary lifestyle, high level of alcohol consumption & low intake of fruits and veggies - research shows alarming increase in colorectal cancer in young adults 20-49 - concern about carcinogenic properties of nitrates often used in hot dogs, hams, luncheon meats - some studies show that taking NSAIDs & consumption of certain vitamins & minerals including calcium, folic acid, selenium, vitamin E

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- lung cancer is number one cause of cancer death' lung cancer has killed more women than breast cancer & is leading cause of cancer deaths for both men & women in US -2 to 3 people diagnosed with lung cancer are 65 of age or older; fewer than 2% are younger than 45 years old / risks begin to rise at age 40 & continue to climb after - symptoms of lung cancer: persistent cough, blood-streaked sputum, voice change, chest or back pain, recurrent attacks of pneumonia or bronchitis -CT scans, molecular markers in saliva, & newer biopsy techniques have improved screening accuracy for lung cancer - treatment depend son type & stage of cancer / surgery, radiation, chemotherapy, & targeted biological therapies - if cancer is localized surgery is usually treatment of choice , if it has spread surgery is combined with radiation, chemo, & other targeted drug treatments - fewer than 15% lung cancer cases are diagnosed at early localized stages since symptoms dont present until cancer is well advanced - lung cancer is deadly / while nearly half of people diagnosed with earliest stage lung cancers survive for at least 5 years those diagnosed in later stages have 5 year survival rates ranging between 1-14% - over 80% of cases occur among smokers - 15-20% of all lung cancers occur among never smokers / never smokers lung cancer is believed to be related to exposure to radon gas, secondhand smoke, asbestos, indoor wood-burning stoves & aerosolized oils caused by cooking with oil & deep fat frying

11. 3

- major cardiovascular diseases: hypertension, atherosclerosis, coronary heart disease & stroke / these cause deaths & disabilities [blood pressure:] - force exerted on artery walls as heart pumps - measured by 2 #s (ex: 110/80 mmHg stated as "110 over 80 millimeters of mercury) - top number is systolic pressure: pressure applied to walls of arteries when heart contracts, pumping blood to rest of body -bottom number is diastolic pressure: pressure applied to walls of arteries during heart's relaxation phase, when blood reenters chambers of heart in preparation for next heartbeat -2200 Americans die every day of CVD - high blood pressure/ hypertension: sustained high blood pressure - historically blood pressure has been 140 or above but in November 2017 It's 130/80 millimeters of mercury -isolated systolic hypertension (ISH) :when only systolic pressure is high / most common form of high blood pressure -higher your blood pressure, the greater the risk for CVD / blood pressure that remains in a higher-than-optimal range can lead to heart or vessel damage over time, increasing chance of heart attack, stroke, heart failure, kidney damage etc -hypertension is known as silent killer / has fewer overt symptoms so people often don't know they have it - 45%: African Americans ethnic group with highest rate of high blood pressure in US, rates are higher among men, older adults, & people who don't have high school education -systolic blood pressure increases with age, diastolic blood pressure increases until age 55 & then declines - prevalence rates in men under age of 45 are expected to triple under new definition with rates among women doubling -women have higher rates of hypertension after age 65 - hypertension treatment: dietary changes like reducing sodium intake, weight loss (when appropriate), regular exercise, reducing alcohol consumption, treatment of sleep disorders like sleep apnea, practice of relaxation techniques & effective coping & communication skills, use of diuretics & other meds like beta-blockers, alpha-blockers, or ACE inhibitors may also be part of treatment -drugs alone do not cure hypertension; majority of people being treated with drugs don't have their blood pressure under control

11. 5

- out of all major cardiovascular diseases, coronary heart disease is the greatest killer / 1 in 7 deaths in US (over 360,000 people) -over 700,00 new & recurrent heart attacks occur in US each year - myocardial infarction (MI) or heart attack: medical emergency where an area of heart suffers permanent damage because It's normal blood supply becomes blocked leading to lack of oxygen & cell death -coronary thrombosis: (causes heart attacks) formation of a clot that blocks blood flow or from an atherosclerotic narrowing that blocks a coronary artery (artery supplying heart muscle with blood) -when clot/thrombus becomes dislodged & moves through circulatory system It's called an embolus -whenever blood does not flow readily, there is a corresponding decrease in oxygen flow to tissue below blockage - if blockage is extremely minor an otherwise healthy heart will adapt over time, enlarging existing blood vessels & growing new ones to reroute needed blood through other areas - collateral circulation: form of self-preservation that allows an affected heart muscle to cope with damage - when heart blockage is more severe body is unable to adapt on It's own & outside life-saving support is critical / hour immediately after heart attack is most crucial period

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- patients undergo stress test: exercise on a stationary bike or treadmill with an electrocardiogram (ECG), arecord of the heart's electrical activity - or nuclear stress test, which involves injecting radioactive dye & taking images of heart to reveal blood flow problems - angiography (cardiac catheterization): thin tube called a catheter is threaded through heart arteries, a dye is injected, & an x ray is taken to identify blocked areas - positron emission tomography (PET) scan produces three-dimensional images of the heart as blood flows through it -magnetic resonance imaging (MRI): magnetic fields are used to image body to help identify damage, congenital defects & disease -ultrafast computed tomography (CT) scan: form of sophisticated X-ray is used to evaluate bypass grafts, diagnose ventricular function, & identify irregularities - coronary calcium score is derived from another type of ultrafast CT used to diagnose calcium levels in heart vessels that may increase risk for heart attack / risk from high levels of radiation used in CT scans - coronary bypass surgery: has helped many patients survive coronary blockages or heart attacks / in coronary artery bypass graft (CABG "cabbage") a blood vessel from another site in patients body is removed & implanted in heart to "bypass" blocked coronary arteires so that blood supply is retained for heart tissue - angioplasty: catheter threaded through blocked heart arteries, has a balloon at the tip which is inflated to flatten fatty deposits against arterial walls, allowing blood to flow more freely -laser angioplasty & atherectomy are surgical options ' atherectomy is a procedure that removes plaque -people who undergo angioplasty receive a stent ; steel mesh tube inserted to keep artery open / stents are highly effective but inflammation & tissue growth in area may increase after procedure & in 30% patients treated arteries become clogged again within 6 months - pain reliever asprin has blood thinning qualities / can help prevent heart attacks or improve outcome when a heart attack occurs - clot-busting therapy with thrombolysis can be performed within first 1-3 hours after a heart attack or stroke -thrombolysis involves injecting an agent like tissue plasminogen activator (tPA) to dissolve clot & restore some blood flow & reducing amount of tissue that dies from ischemia - every year more than 1 million Americans survive heart attacks / millions more have a number of medical interventions to help them survive & thrive / rehab may include exercise training & classes on nutrition & CVD risk management

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- risk factors for type 2 (nonmodifiable): being older, certain ethnicities, genetic factors, biological factors - almost 10% of US population have diabetes & 25% of them don't know it -86 million have prediabetes with elevated blood glucose levels thata re rising but are not yet high enough to be classified as diabetic -increasing age & weight are risk factors; over 22% of people age 65 to 74 in US have prediabetes -rates of type 2 are up among 10-19 year olds particularly among minorities - rates among hispanics, native americans, asian/pacific islanders, non-hispanic black, non-hispanic white have increased females have higher rates than males - modifiable risk factors: body weight, dietary choices, level of physical activity, sleep patterns, stress level - in adults, BMI of 25 or greater increases risks with significantly higher risks for each 5 kg/m^2 increase -central adiposity: excess weight around waistline, risk factor for older women & younger adults -people with type 2 who lose weight & increase their physical activity can significantly improve their blood glucose levels - diabetes is common among people with low socioeconomic status (SES) & in racial & ethnic minorities independent of current SES - An estimated 86 million Americans age 20 or older—37 percent of the adult population—have a set of symptoms known as prediabetes, a condition in which blood glucose levels are higher than normal but not high enough to be classified as diabetes - Prediabetes is one of a cluster of six conditions linked to overweight and obesity that together constitute a dangerous health risk known as metabolic syndrome (MetS) - A person with MetS is five times more likely to develop type 2 diabetes than is a person without the syndrome - A third type of diabetes, gestational diabetes, is a state of high blood glucose during pregnancy, thought to be associated with metabolic stresses that occur in response to changing hormonal levels. As many as 18 percent of pregnancies are affected by gestational diabetes, posing added risks for the mother and developing fetus.163 Between 40 and 50 percent of women with gestational diabetes may progress to type 2 diabetes if they fail to make significant lifestyle changes - Common symptoms of diabetes are similar for type 1 and type 2: Thirst and excessive urination. Kidneys filter excessive glucose by diluting it with water. This can pull too much water from the body and result in dehydration and increased need to urinate. Weight loss. Because so many calories are lost in the glucose that passes into urine, a person with diabetes often feels hungry. Despite eating more, he or she typically loses weight. Fatigue. When glucose cannot enter cells, fatigue and weakness become inevitable. Nerve damage. High glucose levels damage the smallest blood vessels of the body, leading to numbness and tingling. Blurred vision. High blood glucose levels can dry out the cornea or damage microvessels in the eye. Poor wound healing and increased infections. High levels of glucose can affect ability to ward off infection and overall immune function. - diabetes complications: Diabetic coma. In the absence of glucose, body cells break down stored fat for energy. This produces acidic molecules called ketones, excessive amounts of which dangerously elevate blood acid. The diabetic slips into a coma and, without prompt medical intervention, can die. Cardiovascular disease. Because many diabetics are also overweight or obese, hypertension is often present. Blood vessels become damaged and essential nutrients and other substances are not transported as effectively. Kidney disease. Kidneys become scarred by their extraordinary workload and by high blood pressure in their blood vessels. More than 247,000 Americans are currently living with kidney failure due to diabetes.165 Amputations. More than 60 percent of non-trauma-related amputations of legs, feet, and toes are due to diabetes. Each year, nearly 73,000 non-trauma-related lower-limb amputations are performed on people with diabetes.166 Eye disease and blindness. Nearly 7.7 million people over the age of 40 have early-stage retinopathy, which could lead to blindness without treatment.167 Infectious diseases. People with diabetes have increased risk of poor wound healing and greater susceptibility to infectious diseases, particularly influenza and pneumonia. Other complications. People with diabetes may have gum and tooth disease, foot neuropathy, and chronic pain that makes walking, driving, and simple tasks more difficult. In addition, people with diabetes are more likely to suffer from depression, making intervention and treatment more difficult. - key steps to reducing risk for diabetes: Eat smaller portions, and choose foods with less fat, salt, and added sugars. Keep calories equal to energy expended. Eat more fruits, vegetables, and complex carbohydrates, and make sure you consume lean protein. Get your body moving. Aim for at least 30 minutes of moderate activity 5 days a week. Quit smoking; in addition to cancer and heart disease, smoking increases blood glucose levels. Reduce or eliminate alcohol consumption. Alcohol is high in calories and can interfere with blood glucose regulation. Get enough sleep. Inoculate yourself against stress. Learn to take yourself less seriously; find time for fun; develop a strong support network; and use relaxation skills, yoga, meditation, and other mindfulness strategies. If you have a family history of diabetes or several risk factors, get regular checkups.

11. 13

- types of cancers are grouped into four categories based on type of tissue where cancer arises: carcinomas: epithelial tissues (tissues covering body surfaces & lining most body cavities) most common sites for cancers; cancers occurring in epithelial tissue are called carcinomas, they affect outer layer of skin & mouth & mucous membranes / they metastasize through circulatory or lymphatic system & form solid tumors sacromas: occur in mesodermal ,or middle layers, layers of tissue like bones, muscles, & general connective tissue / in early stages of disease they metastasize primarily via blood / these are less common but generally more virulent than carcinomas & form solid tumors lymphomas: develop in lymphatic system - the infection-fighting regions of body - & metastasize through lymphatic system (hodgkins disease is an example/ they form solid tumors leukemias: cancer of blood forming parts of body particularly the bone marrow & spleen is called leukemia / nonsolid tumor is characterized by an abnormal increase in number of white blood cells that body produces